One-month postoperative α-blocker therapy reduces morbidity and increases patients' satisfaction and well-being following water jet aquablation for treating benign prostatic obstruction: a randomized prospective trial.

Introduction: The study aimed to evaluate whether continuing α-blocker therapy for one month after aquablation improves early clinical outcomes in patients undergoing surgery for benign prostatic obstruction (BPO). Material and methods: This prospective, single-center study enrolled 240 consecutive patients with symptomatic BPO who underwent aquablation between 2023 and 2025. Patients were divided into two cohorts: cohort A (n = 120) discontinued BPH medications postoperatively, while cohort B (n = 120) continued α-blocker therapy for one month. Functional, sexual, and safety outcomes were assessed at 3, 6, and 12 months using validated tools (IPSS, QoL, VAS, IIEF, MSHQ-EjD-SF, SF-ICIQ). Statistical analysis was used to compare symptom scores, complication rates, and retreatment frequencies between groups. Results: Both cohorts experienced significant symptom improvement following aquablation. However, cohort B showed superior early outcomes, including a greater reduction in irritative symptoms (p = 0.014 at 3 months; p = 0.02 at 12 months), lower VAS pain scores, and fewer postoperative complications (22.5% vs 30.8%, p = 0.15), with nonsignificantly lower rates of moderate (Grade II) complications in cohort B. Sexual function remained stable in both groups, with cohort B demonstrating improved ejaculatory function scores at all time points. No increase in adverse events was observed with continued use of α-blockers. Conclusions: Short-term continuation of α-blocker therapy following aquablation enhances early postoperative recovery, reduces complications, and improves patient-reported well-being without compromising sexual or functional outcomes. Routine one-month α-blocker therapy is a valuable adjunct in aquablation postoperative care.